Individual
MR. CHAD LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1130 N WESTFIELD ST, OSHKOSH, WI 54902-3217
(920) 237-2163
Mailing address
1130 N WESTFIELD ST, OSHKOSH, WI 54902-3217
(920) 237-2163
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10578-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36111800
—
WI
Enumeration date
08/08/2008
Last updated
08/08/2008
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